| NPI | 1871822361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: GA PSY003322) |
| Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: AL 1579) |
| Enumeration Date | 2009-12-14 |
| Last Update Date | 2011-11-03 |